Provider Demographics
NPI:1740381136
Name:MCNAMARA, ROBERT DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 SIBLEY MEMORIAL HWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1736
Mailing Address - Country:US
Mailing Address - Phone:651-455-4223
Mailing Address - Fax:
Practice Address - Street 1:880 SIBLEY MEMORIAL HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55118-1736
Practice Address - Country:US
Practice Address - Phone:651-455-4223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN91021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice